Valvular Heart Disease

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Significant valvular heart disease is present in about 2 % of the population. The most common serious valve condition is calcific aortic stenosis (AS), with severe disease presenting in older adults with symptoms of decreased exercise tolerance or dyspnea and a systolic murmur. Valve replacement is lifesaving and is recommended regardless of patient age. Mitral stenosis is a late consequence of rheumatic heart disease and now is treated with percutaneous balloon commissurotomy in most patients. Mitral valve regurgitation often is secondary to other cardiac conditions, such as dilated cardiomyopathy and coronary disease, with treatment directed toward the underlying disease process. In patients with primary mitral regurgitation, for example, due to mitral valve prolapse, surgical repair often provides durable relief of valve dysfunction without the need for a prosthetic valve. Aortic regurgitation may be due to disease of the valve leaflets, such as a bicuspid valve, or to dilation of the aorta; treatment depends on the cause of valve dysfunction. Acute aortic or mitral regurgitation is a medical and surgical emergency with a range of causes including aortic dissection, endocarditis, and spontaneous mitral chordal rupture. Acute valve regurgitation often is misdiagnosed because a typical murmur may not be present; echocardiography should be considered in all patients with acute pulmonary decompensation. Patients with prosthetic heart valves require careful management to prevent endocarditis and to provide optimal antithrombotic therapy, as well as to monitor valve function. Endocarditis has mortality rate as high as 40 % at 1 year; management requires collaborative care by cardiologists, cardiac surgeons, and infectious disease specialists.